Provider Demographics
NPI:1457095051
Name:ALAM, A B M NASIBUL (MBBS)
Entity type:Individual
Prefix:
First Name:A B M NASIBUL
Middle Name:
Last Name:ALAM
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MEDICAL CENTER DRIVE
Mailing Address - Street 2:NORTHWESTERN MEDICINE MCHENRY HOSPITAL
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-344-5000
Mailing Address - Fax:
Practice Address - Street 1:4201 MEDICAL CENTER DRIVE
Practice Address - Street 2:NORTHWESTERN MEDICINE MCHENRY HOSPITAL
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-344-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2023-08-07
Deactivation Date:2023-01-18
Deactivation Code:
Reactivation Date:2023-04-26
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.080879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program